News In Healthcare

I am lucky. I have pretty good health insur­ance cov­er­age. But I have heard that peo­ple who do not have health insur­ance or those who don’t have great cov­er­age are check­ing web­sites like Groupon or Liv­ing Social for dis­counts for var­i­ous medical/dental ser­vices. Because I am curi­ous by nature, I checked Groupon to see what dis­counts were avail­able in my area. I found that the dis­counts were for mas­sages and cos­metic work. On Liv­ing Social I found dis­counts for den­tal exams in addi­tion to the stan­dard spa services.

It seems the dis­count sites are not yet pop­u­lar for med­ical ser­vices. This may change depend­ing upon the out­come of the US Supreme Court review of the fed­eral health law. In the mean­time, if you need med­ical ser­vices and you don’t have health insur­ance, don’t avoid the doc­tor. Most med­ical providers will offer dis­counts directly to their patients, even with­out a Groupon coupon.

We are about 2 months away to the US Supreme Court hear­ing argu­ments on the con­sti­tu­tion­al­ity of the fed­eral health law. To help keep track of the briefs filed, the news reports and the analy­sis of the argu­ments, Kaiser Health News has put together a site to help us all keep score. If you want to fol­low the case, this site is def­i­nitely worth check­ing out.

I can­not believe that we needed to con­duct a study in order to know that indi­vid­u­als who under­stand their health insur­ance cov­er­age require­ments, will make bet­ter choices about seek­ing med­ical ser­vices.  The Boston Her­ald recently pub­lished the find­ings of just such a study.  What was found was that indi­vid­u­als who knew what their co-payments were for med­ical ser­vices were more cost-conscious when decid­ing when to seek those med­ical ser­vices.  These indi­vid­u­als were con­sid­ered “savy.”

I don’t call it being savy.  I call it using com­mon sense.  If you know that each emer­gency room visit is going to require you to pay $250 out of your pocket  ver­sus $25 for each physi­cian office visit, com­mon sense says that you will visit your physi­cian and not the hos­pi­tal emer­gency department.

It is not sur­pris­ing that when a new law is issued that requires that 38 mil­lion peo­ple to obtain health insur­ance, that some­one is going to jump in right away and start sell­ing insur­ance cov­er­age to these indi­vid­u­als.  The prob­lem is that the first one in is usu­ally the scam artist try­ing to take advan­tage of the con­fu­sion sur­round­ing the new require­ments and the vul­ner­a­bil­ity of cer­tain seg­ments of our pop­u­la­tion.  Rec­og­niz­ing that the insur­ance scams have already started, Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius sent let­ters to the state Attor­ney Gen­er­als and Insur­ance Com­mis­sion­ers on April 6, 2010 warn­ing them of the practices.

The state offi­cials have been asked to be on the look­out for these fraud­u­lent door-to-door insur­ance sales peo­ple and 1–800 schemes.  The state offi­cials are to send bul­letins to their state pop­u­la­tion warn­ing them of these prac­tices.  A sud­den require­ment to cover 38 mil­lion Amer­i­cans is cer­tainly excit­ing to the insur­ance indus­try and those plans that are not above-board will cer­tainly try to max­i­mize their sales.  Before hand­ing over a check to cover the pre­mium pay­ment for your new health insur­ance plan, please be sure to check out your state Depart­ment of Insur­ance web­site or call your Insur­ance Com­mis­sioner to ver­ify the valid­ity of the plan.

In a let­ter to Health and Human Ser­vices Sec­re­tary Kath­leen Sebe­lius, Karen Ignagni head of America’s Health Insur­ance Plans and the nation’s top health insur­ance indus­try offi­cial, said that the indus­try will fully com­ply with new reg­u­la­tions pre­vent­ing cov­er­age denials for chil­dren with pre-existing con­di­tions.  The reg­u­la­tions are expected to be issued within the next few weeks.

It is trou­bling that Ms. Ignagni was in a posi­tion where she had say to the fed­eral gov­ern­ment that the health insur­ance indus­try will fol­low the rules and not cause prob­lems.  How­ever it is believ­able that this was required given the recent actions by health plans to hap­haz­ardly rescind cov­er­age based upon pre-existing conditions.

Read­ing the first line of this arti­cle in the New York Times, The Many Hid­den Costs of High-Deductible Health Insur­ance, made me think back to our recent post regard­ing choos­ing the right health insur­ance and the fact that young Amer­i­cans are will­ing to do the research but not sure where to turn for assis­tance. This arti­cle pro­vides a detailed under­stand­ing of what addi­tional costs may be hid­den in the high-deductible health insur­ance plans.

I can’t believe that it was back on 9/28/06 when we posted our first item on the prob­lems Cal­i­for­nia insur­ers were fac­ing for wrong­fully rescind­ing patients’ poli­cies.  Almost three years later, we are still hear­ing about cases where Blue Shield of Cal­i­for­nia and Health­Net are still under fire for rescind­ing poli­cies.   The AP is report­ing that Health­Net just entered into a set­tle­ment with a class of patients where Health­Net will cre­ate a $1.95 mil­lion fund to pay those patients’ out­stand­ing med­ical costs.  Blue Shield, on the other hand, has seen a dif­fer­ent turn of events.  A Cal­i­for­nia judge ruled yes­ter­day that Blue Shield was right to drop the pol­icy of a man who sued the insurer for wrong­fully ter­mi­nat­ing his pol­icy.  The judge foudn that Blue Shield con­ducted an appro­pri­ate inves­ti­ga­tion of the mat­ter and deter­mined that the patient’s spouse did in fact know­ingly mis­rep­re­sent infor­ma­tion on the patient’s insur­ance application.

I love to see where the largest pay­ers rank when it comes to per­cent­age of claim denials, days in A/R, denial trans­parency.  That is why I was so excited to see the new report issued by Athena Health.  This site allows you to ana­lyze payer per­for­mance by region and by issue.  Can you believe that Unit­ed­Health Group ranks #1 in the nation for the per­cent­age of denied claims that close with only one addi­tional resub­mis­sion?  Of course they ranked 4th in the per­cent­age of denied claims requir­ing addi­tional work on the back-end.

Health insur­ance is clearly a neces­sity but where do we go to choose what is right for us? Sounds like many young Amer­i­cans are in the same quandary when it comes to this ques­tion. A recent study reported by Dow Jones Newswire shows that young Amer­i­cans do not feel they have the infor­ma­tion needed to make the right deci­sion about health insur­ance cov­er­age. The poll fur­ther found that while the indi­vid­u­als were will­ing to research their options, many felt they lacked the proper resources.

Watch out friends! If you are con­duct­ing research online be sure you know who is shar­ing this infor­ma­tion with you. Many insur­ance com­pa­nies want you to believe you are get­ting tremen­dous cov­er­age for small monthly pre­mium pay­ments but hid­den in the pol­icy they will make a por­tion of the claims your responsibility.

To share a per­sonal exam­ple, just a year ago Trilogi, Inc. my employer, polled the staff to choose between two health plans: one plan that cost a bit more monthly but pro­vided greater cov­er­age includ­ing lower deductibles and out-of-pocket costs, and a sec­ond plan that cost less each month but that pro­vided less cov­er­age and had a higher deductible. At the time, the staff was rel­a­tively new in deal­ing with health insur­ance issues so a major­ity opted for the “cheaper” monthly pre­mium. After a year of fol­low­ing up with insur­ance car­ri­ers and see­ing just how much insur­ance car­ri­ers are leav­ing as patient respon­si­bil­ity, we polled the same group of indi­vid­u­als to see which type of plan they would choose now and to no sur­prise, the group stated they would rather pay a few dol­lars more each month for bet­ter cov­er­age in the long run.

We all know that there is a grow­ing cost to med­ical providers ren­der­ing ser­vices to the unin­sured pop­u­la­tion — approx­i­mately $42.7 bil­lion went unpaid last year.  We also know that some­one has to be con­tribut­ing to pay­ing for that care.  But did you know that that cost is being cov­ered through a hid­den tax on the pre­mi­ums of peo­ple with insur­ance?  Accord­ing to today’s USA Today, the aver­age U.S. fam­ily and their employ­ers paid an extra $1,017 in health care pre­mi­ums last year to com­pen­sate for the uninsured.

What is miss­ing from the stud­ies done and the state­ments made at the con­gres­sional hear­ings is that on top of pay­ing a “hid­den tax” on our pre­mi­ums, most insureds are actu­ally “under­in­sured” and end up foot­ing most of their health­care expenses because of high deductibles or insur­ance denials.  To be pay­ing a tax on top of that for health­care ser­vices not ren­dered to those indi­vid­u­als is just one more rea­son why the cur­rent health insur­ance indus­try needs imme­di­ate reform.